Skip to main content


Log in

A case of atypical thyrotroph cell adenoma, which re-grew within 3 months after surgery and required multimodal treatment

  • Clinical-Patient Studies
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript


Objective and importance Thyrotroph cell adenoma accounts for only 1% of all pituitary adenomas. This tumor is tough and firm because of significant interstitial fibrosis, and is difficult to remove. Atypical adenoma has an aggressive biological character, invades the surrounding structures, and grows rapidly. Atypical thyrotroph cell adenoma is extremely rare. Clinical presentation A 32-year-old man presented with hyperthyroidism and bitemporal hemianopsia. Head magnetic resonance imaging revealed a large sellar tumor compressing the optic chiasma and invading the left cavernous sinus. Intervention Transsphenoidal surgery was performed and subtotal removal was achieved. Histological examination showed atypical thyrotroph cell adenoma. Gamma knife surgery was planned, but the tumor re-grew within 3 months, and reattached to the optic chiasma. Second transcranial surgery failed to remove residual tumor behind the pituitary stalk. Conventional irradiation followed by octreotide administration resulted in decreased tumor size and stable euthyroidism. The tumor has been controlled for 22 months since first surgery and diagnosis. Conclusion Atypical thyrotroph cell adenoma has an aggressive biological character and grows rapidly. Multimodal treatment including medication and radiotherapy is required.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others


  1. Bertholon-Greoire M, Trouillas J, Guigard MP, Loras B, Tourniaire J (1999) Mono- and plurihormonal thyrotropic pituitary adenomas: pathological, hormonal and clinical studies in 12 patients. Eur J Endocrinol 140:519–527

    Article  Google Scholar 

  2. Delellis RA, Lloyd RV, Heitz PU, Eng C (eds) (2004) Pathology and genetics of tumors of endocrine organs. International Agency for Research on Cancer, Lyon

    Google Scholar 

  3. Kovacs K, Horvath E (eds) (1986) Tumors of the pituitary gland, 2nd series. Armed Forces Institute of Pathology, Washington

    Google Scholar 

  4. Socin HV, Chanson P, Delemer B, Tabarin A, Rohmer V, Mockel J, Stevenaert A, Beckers A (2003) The changing spectrum of TSH-secreting pituitary adenomas: diagnosis and management in 43 patients. Eur J Endocrinol 148:433–442

    Article  PubMed  CAS  Google Scholar 

  5. Sanno N, Teramoto A, Osamura Y (2001) Thyrotropin-secreting pituitary adenomas. Clinical and biological heterogeneity and current treatment. J Neurooncol 54:179–186

    Article  PubMed  CAS  Google Scholar 

  6. Lloyd RV, Kovacs K, Young WF Jr, Farrel WE, Asa SL, Trouillas J, Kontogeorgos G, Sano T, Scheithauer BW, Horvath E (2004) Pituitary tumours: introduction. In: DeLellis RA, Lloyd RV, Heitz PU, Eng C (eds) WHO classification of tumours. Pathology and genetics. Tumours of endocrine organs. IARC Press, Lyon, pp 10–13

    Google Scholar 

  7. Kontogeorgos G (2005) Classification and pathology of pituitary tumors. Endocrine 28:27–35

    Article  PubMed  CAS  Google Scholar 

  8. Kontogeorgos G (2006) Predictive markers of pituitary adenoma behavior. Neuroendocrinology 83:179–188

    Article  PubMed  CAS  Google Scholar 

  9. Saeger W, Ludecke DK, Buchfelder M, Fahlbusch R, Quabbe HJ, Petersenn S (2007) Pathohistological classification of pituitary tumors: 10 years of experience with the German pituitary tumor registry. Eur J Endocrinol 156:203–216

    Article  PubMed  CAS  Google Scholar 

  10. Thapar K, Scheithauer BW, Kovacs K, Pernicone PJ, Laws ER Jr (1996) P53 expression in pituitary adenomas and carcinomas: correlation with invasiveness and tumor growth fractions. Neurosurgery 38:765–771

    Article  PubMed  CAS  Google Scholar 

  11. Ikeda H, Ogawa Y, Yoshimoto T (1999) Ultrastructural characteristics of TSH-producing adenomas with special reference to its close similarity to BFA-treated pituitary adenoma cells. Pituitary 1:221–226

    Article  PubMed  CAS  Google Scholar 

  12. Ogawa Y, Ikeda H, Yoshimoto T (1996) Ultrastructural changes in cells of human pituitary adenoma treated by Brefeldin A. Jpn J Clin Electron Microsc 29:69–75

    Google Scholar 

  13. Ogawa Y, Tominaga T, Ikeda H (2007) Intrasellar small TSH secreting pituitary adenomas, 2 case reports. No Shinkei Geka 35:679–684

    PubMed  Google Scholar 

  14. Brucker-Davis F, Oldfield EH, Skarulis MC, Doppman JL, Weintraub BD (1999) Thyrotropin-secreting pituitary tumors: diagnostic criteria, thyroid hormone sensitivity, and treatment outcome in 25 patients followed at the National Institutes of Health. J Clin Endocrinol Metab 84:476–486

    Article  PubMed  CAS  Google Scholar 

  15. Patrick AW, Atkin SL, MacKenzie J, Foy PM, White MC, MacFarlane IA (1994) Hyperthyroidism secondary to a pituitary adenoma secreting TSH, FSH alpha-subunit and GH. Clin Endocrinol (Oxf) 40:275–278

    CAS  Google Scholar 

  16. Sanno N, Teramoto A, Osamura Y (2000) Long-term surgical outcome in 16 patients with thyrotropin pituitary adenoma. J Neurosurg 93:194–200

    Article  PubMed  CAS  Google Scholar 

  17. Beck-Peccoz P, Persani L (2002) Medical management of thyrotropin-secreting pituitary adenomas. Pituitary 5:83–88

    Article  PubMed  CAS  Google Scholar 

  18. Caron P, Arlot S, Bauters C, Chanson P, Kuhn JM, Pugeat M, Marechaud R, Teutsch C, Vidal E, Sassano P (2001) Efficacy of the long-acting octreotide formulation (octreotide-LAR) in patients with thyrotropin-secreting pituitary adenomas. J Clin Endocrinol Metab 86:2849–2853

    Article  PubMed  CAS  Google Scholar 

  19. Dhillon KS, Cohan P, Kelly DF, Darwin CH, Iyer KV, Chopra IJ (2004) Treatment of hyperthyroidism associated with thyrotropin-secreting pituitary adenomas with iopanoic acid. J Clin Endocrinol Metab 89:708–711

    Article  PubMed  CAS  Google Scholar 

  20. Mixson AJ, Friedman TC, David AK (1993) Thyrotropin-secreting pituitary carcinoma. J Clin Endocrinol Metab 76:529–533

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Yoshikazu Ogawa.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ogawa, Y., Tominaga, T. A case of atypical thyrotroph cell adenoma, which re-grew within 3 months after surgery and required multimodal treatment. J Neurooncol 87, 91–95 (2008).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: